Gastroduodenal tuberculosis: a case series and a management focused systematic review

ABSTRACT

Introduction

Gastroduodenal tuberculosis is an uncommon form of abdominal tuberculosis.

Areas covered

We report our experience with five cases of gastroduodenal tuberculosis and present results of a systematic review on gastroduodenal tuberculosis regarding clinical presentation, endoscopic, imaging findings, and the diagnostic and therapeutic approach.

Expert opinion

The presentation of gastroduodenal tuberculosis is diverse and may include nonspecific abdominal pain or dyspepsia like symptoms apart from gastric outlet obstruction. Endoscopy may show presence of growth, ulcer, narrowing, or fistula on endoscopy. Endoscopic biopsy, well-biopsy, or mucosal resection of an elevated lesion are helpful. On microscopy, granuloma with or without acid fast bacilli positivity can be found. For treatment, standard antitubercular therapy should be given for 6 months. In patients with tight stricture, endoscopic balloon dilatation can be helpful. Surgery is reserved for patient with diagnostic dilemma, refractory stricture, or complications like perforation or fistula. Future research should focus on improving diagnosis with use of modern microbiological techniques like PCR and Xpert MTB/RIF.

KEYWORDS:

• Gastric tuberculosis
• duodenal tuberculosis
• gastrointestinal tuberculosis
• intestinal tuberculosis

Article highlights

• Gastroduodenal tuberculosis is an uncommon pattern of abdominal tuberculosis with involvement of the stomach or duodenum.

• The clinical presentation is usually with features of abdominal pain and gastric outlet obstruction in adults while failure to thrive may occur in pediatric age groups

• The diagnosis of gastroduodenal tuberculosis is difficult and may require well biopsies or endoscopic mucosal resection if standard endoscopic biopsies are negative.

• There has been a shift from surgery toward endoscopy for both the diagnosis and treatment (balloon dilatation) in recent years

• The treatment of gastroduodenal tuberculosis includes standard antitubercular therapy, endoscopic dilatation (for strictures) and surgery (in nonresponsive cases)

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose

Additional information

Funding

This paper was not funded.